Provider Demographics
NPI:1902169881
Name:HEUSKIN, DONNA J (MSED)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:HEUSKIN
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-6720
Mailing Address - Country:US
Mailing Address - Phone:516-293-5110
Mailing Address - Fax:
Practice Address - Street 1:53 GRANT ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-6720
Practice Address - Country:US
Practice Address - Phone:516-293-5110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-16
Last Update Date:2012-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1308483174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist